心肺转流对P_（a－E′）CO_2的影响

心肺转流对Ｐ＿（ａ－Ｅ′）ＣＯ＿２的影响张希龙，小柳仁近年来临床上常以呼气未二氧化碳分压（ＰＥ′ＣＯ２）监测动脉血二氧化碳分压（ＰａＣＯ２），具有无创、连续和方便的优点。但也发现某些病理因素可致ＰａＣＯ２与ＰＥＣＯ２之差［Ｐ（ａ－Ｅ′）ＣＯ２］增大。...     

SD大鼠二氧化氮吸入性肺损伤实验研究

目的：探讨二氧化氮（NO2）吸入性肺损伤的机制。方法：采用实验－对照设计方法,对30只SD大鼠肺组织内丙二醛（MDA）、谷胱甘肽（GSH）、总抗氧化能力（T－AOC）进行比较。结果：NO2吸入组SD大鼠肺组织内MDA值显著高于对照组,而T－AOC值则低于对照组,均有显著意义。只有长期NO2吸入组的SD大鼠GSH值显著低于对照组。结论：SD大鼠吸入NO2后,氧化物质与抗氧化物质失衡所导致的氧化性肺损伤,是肺损伤的重要机制。     

Epidemiological investigation of Histoplasma capsulatum infection in China

Objectives To provide reliable information concerning the presence or the absence of Hist oplasma capsulatum (H. capsulatum) infection in China, and data concerning th is respect. Methods Three hundred normal people and 435 hospitalized patients, who lived in Hunan an d Jiangsu provinces, and the Xinjiang Autonomous Region, were tested with yeast -phase histoplasmin (ALK/Berkerley Biologicals Laboratories, USA) and human pur e protein derivative of tuberculin (PPD) on the volar surface of the forearm. A ny reaction to the antigens over 5.0 mm in diameter of induration at 48-72 ho urs was considered positive. Results A total of 138 subjects (18.8%) in 735 patients reacted to histoplasmi n with 5.0-45.0 (9.1±4.3) mm indurations. Significant differences of positive skin reaction rates in norm al subjects were found in Hunan, Jiangsu and Xinjiang (8.9% vs 15.1 % vs 2.1%). The overall positive rate of patients was 25.5%. Patients with t uberculosis ［31.7% (78/246)］ had a significantly higher positive skin reactio n rate in comparison with those suffering from pneumonia ［17.7% (11/62)］, lun g cancer ［20.9% (9/43)］, chronic obstructive pulmonary disease ［17.3% (9/52 )］ and other diseases ［12.5% (4/32)］ (P<0.01). Of 562 cases, 292 case s (52.0%) reacted to PPD with indurations of 5-50 (13.7±4.9)mm in diameter, 63 cases (11.2%) reacted to both histoplasmin and PPD, while 38 cases (6.9%) reacted to histoplasmin but not to PPD. Conclusions The data suggest that there is H. capsulatum herd infection in China. The infection rate in Southeast China is higher than that in the Northwest, and the infection rate of patients with pulmonary tuberculosis is higher than that of no rmal persons and other pneumonopathy patients.     

持续气道正压通气治疗阻塞性睡眠呼吸暂停低通气综合征的现状和展望

1981年Sullivan首次在临床应用持续气道正压通气(continuous positive airway pressure,CPAP)治疗阻塞性睡眠呼吸暂停低通气综合征(obstructivesleep apnea hypopnea syndrome,OSAHS),迄今CPAP     

重叠综合征患者夜间缺氧与生活质量评分的相关性研究

目的探讨慢性阻塞性肺病(COPD)合并阻塞性睡眠呼吸暂停低通气综合征(OSAHS),即重叠综合征(OS)患者的夜间缺氧与生活质量的相关性。方法观察对象105例,其中COPD组30例,OSAHS组30例,OS组25例,正常对照组20例,所有患者均行肺功能测定和多导睡眠呼吸监测(PSG),填写生活质量呼吸问卷和贝克抑郁量表(BDI),并对各组数据做统计学单因素方差分析,同时对生活质量评分和贝克抑郁评分的相关因素做相关分析和多元回归分析。结果在比较COPD组和OS组第1秒钟用力呼气容积占预计值的百分比(FEV1占预计值%)、第1秒钟用力呼气容积占用力肺活量的百分比(FEV1/FVC)差异无显著性的情况下,OS组的Epworth评分、浅睡眠所占百分率(S1+S2)%、微觉醒指数、呼吸暂停低通气指数(AHI)、血氧饱和度<90%的时间占总监测时间的百分比(TS90%)、氧减指数(ODI)、氧减事件时间/小时、均明显高于COPD组(P均<0.05)。OS组的最长呼吸暂停时间(LAT)、生活质量评分、BDI评分均明显高于其他3组(P均<0.05),而最低血氧饱和度(LSaO2)、平均血氧饱和度(MSaO2)则明显低于其他3组(P均<0.05)。OS组生活质量评分与TS90%、ODI、氧减事件时间/小时具有很好的相关性(相关系数分别为0.543、0.651、0.769,P<0.05);而且这3种缺氧指标和BDI同样具有很好的相关性(相关系数分别为0.490、0.568、0.622,P均<0.05)。多元回归分析显示,OS组患者生活质量评分与氧减事件时间/小时正相关(P<0.05),AHI、微觉醒指数、BMI、睡眠效率等未进入回归方程,而BDI评分则与氧减事件时间/小时和微觉醒指数正相关(P<0.05)。结论重叠综合征患者与单纯的COPD患者和OSAHS患者相比,睡眠相关的缺氧程度更严重,因夜间缺氧而引起健康等相关生活质量情况更差,抑郁程度更重。     

双水平气道正压通气对重叠综合征患者心功能及血管内皮功能影响

目的 探讨双水平气道正压通气(BiPAP)对重叠综合征(OS)患者心功能及血管内皮功能的作用机制.方法 对2009年1月至2010年9月南京医科大学附属江宁医院呼吸科睡眠监测室进行多导睡眠监测(PSG)的人群进行筛选,共入选患者120例,其中男87例,女33例,年龄40～53岁,平均(48±4)岁;根据肺功能及PSG检查结果分为:对照组、OSAHS组、COPD组和OS组.所有人群均测定肺功能指标:FEV1占预计值%、FEV1/FVC和峰值呼气流速(PEF%);心功能指标和血管内皮功能指标:内皮素-1、一氧化氮和凝血酶-Ⅲ;PSG指标:AHI、LSaO2及SaO2＜90%时间.OS组患者经BiPAP治疗并随访一个月,记录治疗前后的各项指标并比较.组间比较采用单因素方差分析,组间两两比较采用LSD法,治疗前后比较采用配对t检验.结果 OS组患者FEV1占预计值%为(48±7)%、FEV1/FVC为(46±6)%和PEF%为(47.5±5.3)%均明显低于其他3组(F值为215.47～681.65,均P＜0.05),血管内皮功能明显受损,内皮素-1含量为(48±10)ng/L(F值为46.61～259.12,均P＜0.05);经BiPAP治疗后,OS患者心肺功能及血管内皮功能得到明显改善,FEV1占预计值%、FEV1/FVC及PEF%分别为(58±7)%、(56±7)%及(57.5±2.5)%,内皮素-1含量降至(38±8)ng/L(t值为-17.13～42.06,均P＜0.05).结论 OS可引起明显的低氧血症,从而促使血管内皮功能严重受损.BiPAP治疗能明显改善与呼吸暂停有关的低氧,从而调节血管内皮的功能,可能会成为预防OS合并心血管疾病的重要途径.

Abstract：

Objective To study the mechanism of Bi-level positive airway pressure(BIPAP) on the heart function and the vascular endothelial function of the overlap syndrome(OS). Methods There were 87 males and 33 females (mean age 48 ±4, range 40 -53 years) admitted to the Affliliated Jiangning Hospital respiratory department of Nanjing Medical University. Subjects tested with PSG were allocated to normal,OSAHS, COPD and OS groups by the result of pulmonary function testing. All persons were tested with pulmonary function (FEV1% of predicted, FEV1/FVC% , PEF% ), heart function (Tei index, BNP),vascular endothelial function(ET-1, NO, AT-Ⅲ ) and PSG( AHI, LSaO2, the time of SaO2 ＜90% ). The measurements were repeated in patients with OS after BiPAP treatment and 1 month after follow-up. One-way ANOVA was used for comparison between 2 groups. Post-hoc multiple comparisons of means were performed by using LSD. Paired-samples t Test was used for comparison of data between baseline and post-treatment.Results The FEV1% of predicted, FEV1/FVC%, and PEF% in the OS group were significantly lower than the those in the other groups ( F = 215.47 - 681.65, P ＜ 0. 05 ). The vascular endothelial function was impaired more severely than the other groups ( F = 46. 60 - 259. 12, P ＜ 0. 05 ). The heart function,pulmonary function, and vascular endothelial function were significantly improved after BiPAP treatment( t =-17. 13- 42.06, P ＜ 0. 05 ). Conclusion The vascular endothelial dysfunction is associated with OS.Treatment by BiPAP can improve hypoxia and vascular endothelial function, and therefore may be useful in prevention of cardiovascular disease in OS.     

慢性间歇低氧对大鼠颏舌肌细胞线粒体功能的影响及脂联素的干预作用

目的 探讨慢性间歇低氧(CIH)对大鼠颏舌肌细胞线粒体功能的影响及脂联素干预作用.方法 健康雄性Wistar大鼠39只,采用随机数字表法分成健康对照(NC)组、CIH组、CIH脂联素干预组(CIH+Ad组),每组13只.NC组大鼠呼吸正常空气,CIH组与CIH+Ad组均接受CIH环境(CIH 8 h/d,共5周),CIH+Ad组加用经静脉脂联素注射10 μg/次,2次/周,共5周.于实验终止(第35天)时测定并比较各组大鼠血清脂联素浓度、颏舌肌线粒体膜电位、线粒体复合物Ⅰ活性、线粒体复合物Ⅳ活性.结果 CIH组血清脂联素浓度明显低于NC组[(1108±112)ng/ml,(2241±121)ng/ml,P＜0.01];CIH+Ad组高于CIH组[(1889±119)ng/ml]但低于NC组[(2241±121)ng/ml,均P＜0.01].CIH组颏舌肌线粒体膜电位相对值(1.82±0.11)明显低于NC组(2.09±0.14,P＜0.01),CIH+Ad组(1.98±0.09)较CIH组略高但低于NC组,差异均有统计学差异(均P＜0.05).CIH组线粒体复合物Ⅰ、Ⅳ浓度[(35.68±1.73)μmol·min-1·mg-1,(2.37±0.11)nmol·min-1·mg-1]最低,CIH+Ad组[(37.18±1.95)μmol·min-1·mg-1,(2.49±0.09)nmol·min-1·mg-1]及NC组[(39.02±1.38)μmol·min-1·mg-1,(2.81±0.12)nmol·min-1·mg-1]依次增高.NC组与CIH组比较差异有统计学意义(P＜0.01),CIH+Ad组与CIH组和NC组比较差异有统计学意义(均P＜0.05).结论 CIH可致大鼠血清脂联素水平降低,并能显著损伤颏舌肌细胞线粒体功能,补充外源性脂联素能部分改善CIH对大鼠颏舌肌细胞线粒体功能的损伤,提示低脂联素血症可能参与CIH导致的颏舌肌能量代谢障碍.

Abstract：

Objective To investigate the effect of chronic intermittent hypoxia (CIH) on mitochondrial function in genioglossus cells of rats and intervention role of adiponectin (Ad). Methods Thirty-nine healthy male Wistar rats were randomly divided into 3 groups, normal control (NC) group, CIH group and CIH + Ad group with 13 rats in each. Rats in NC group were kept breathing normal air, while rats in both CIH and CIH + Ad groups experienced the same CIH environment ( CIH 8 h/day for successive 5 weeks). However, rats in CIH + Ad group was given intravenous Ad supplement at the dosage of 10 μg,twice a week for sucessive 5 weeks. At the end of experiment ( day 35 ), the levels of plasma adiponectin,mitochondrial membrane potential activities of respiratory chain complexes Ⅰ and Ⅳ in mitochondrion of genioglossus cells were compared among different groups. Results Serum Ad level was significantly lower in CIH group than that in NC group [(1108 ± 112) ng/ml vs (2241 ± 121) ng/ml, P＜0.01 ]. Serum Ad level in CIH + Ad group [ ( 1889 ± 119) ng/ml] was significantly higher than that in NC group but lower than that in CIH group ( all P ＜ 0. 01 ). Mitochondrial membrane potential was significantly lower in CIH group than that in NC group [ ( 1.82 ± 0. 11 ) vs (2. 09 ± 0. 14), P ＜ 0. 01 ]. Mitochondrial membrane potential in CIH + Ad group ( 1.98 ± 0. 09) was higher than that in CIH group but lower than that in NC group ( all P ＜ 0. 05 ). The concentrations of mitochondrial respiratory chain complexes Ⅰ and Ⅳ in CIH group ( 35.68 ± 1.73 ) μmol · min - 1 · mg- 1 and (2. 37 ± 0. 11 ) nmol · min - 1 ·mg - 1, respectively) were the lowest but became higher from CIH + Ad group [ (37. 18 ± 1.95) μ mol· min-1 · mg-1 and (2. 49 ±0.09) nmol · min-1 ·mg-1 ,respectively] to NC group (39.02 ± 1.38) μmol · min-1 · mg-1 and (2. 81±0. 12) nmol · min-1 ·mg-1 ,respectively), with a significant difference between NC and CIH groups ( P ＜ 0. 01 ), between CIH + Ad and CIH groups ( P ＜ 0. 05 ), as well as between CIH + Ad and NC groups (P ＜ 0. 05 ). Conclusion CIH could lead to hypoadiponectinemia and impaired mitochondrial function in genioglossus cells of rats. Since such changes could be partially improved by supplement of adiponectin, it was suggested that hypoadiponectinemia might be involved in CIH-induced impairment of genioglossus energy metabolism.     

阻塞性睡眠呼吸暂停综合征与脑血管病关系20年随访研究

目的 调查随访阻塞性睡眠呼吸暂停综合征(OSAS)与脑血管病的关系.方法 对1989年11月至2009年11月南京军区所属3市及地区军队和地方离退休干部休养所进行体检的人群进行随访调查,随访期间每年进行1次体检,检查血压、血脂、血糖、心电图及X线胸片等,发现存在脑血管病表现时行头颅CT检查,以发生脑血管病为随访终点,随访时间为20年.结果 共纳入患者1868例,年龄53～82岁,平均(63±6)岁,其中男956例,平均(65±7)岁,女912例,平均(60±6)岁.其中确诊OSAS者598例(32.0%),纳入OSAS组,其中男496例(82.9%),女102例(17.1%);其余为对照组.随访终点比较结果显示,OSAS组白天嗜睡、头痛、记忆力减退、痴呆及语言障碍等发生率明显高于对照组(P＜0.05).OSAS组276例(46.2%)发生脑血管病,对照组发生150例(11.8%)(P＜0.01).随访期间死亡患者817例,其中OSAS组396/598例(66.2%),对照组421/1270例(33.1%,P＜0.01).随访结束时OSAS组脑血管病患病率为276/598例(46.2%),对照组170/1270例(13.4%,P＜0.01).结论 OSAS患者发生脑血管病可能性较一般人群高,考虑OSAS与发生脑血管病存在相关性,提示OSAS可能是脑血管病的独立危险因素.

Abstract：

Objective To explore the correlation between obstructive sleep apnea syndrome (OSAS) and cerebrovascular disease(CVD). Methods A cohort of 1868 people was screened for OSAS,and followed from November 1989 to November 2009. Annual medical examinations including blood pressure,blood fat, serum glucose, electrocardiogram and chest x-ray were performed. Computer tomography was carried out when CVD, the endpoint of the study, was manifested. Results Among the 1868 elderly people, 598 ( 32.0% ) were confirmed to have OSAS, including 496 ( 82.9% ) males and 102 ( 17. 1% )females. Compared with the non-OSAS group, patients with OSAS had more symptoms including daytime somnolence, headache, decreased ability of memory, aphronesia and allolalia( P ＜ 0. 05 ). CVD occurred in 276(46. 2% )patients of the OSAS group, but in 150( 11.8% , P ＜ 0. 01 )subjects of the non-OSAS group.During the 20-year follow-up, 817 people died, 66. 2% (396/598) in the OSAS group, but 33. 1% (421/1270) in the non-OSAS group ( P ＜0. 01 ). Conclusion Patients with OSAS are more likely to suffer from CVD. OSAS may be an independent risk factor for CVD.     

通心络胶囊对老年睡眠期陈-施呼吸患者呼吸的影响

目的观察通心络胶囊对老年睡眠期陈-施呼吸（CSR）患者的影响。方法根据多导睡眠图监测（PSG）结果,除外心力衰竭病因者,入选老年睡眠期CSR患者30例,按呼吸暂停低通气指数分为轻度（n=11）、中度（n=9）及重度（n=10）CSR组,均予口服通心络胶囊2粒／次,3次,d,共30d。分析治疗前后PSG指标及症状的变化及与日间嗜睡程度的相关关系。日间嗜睡程度以Epworth嗜睡评分（ESS）评定。结果通心络胶囊治疗前后比较显示,3组中仅重度组呼吸暂停低通气指数显著降低[（37．4±4．3）vs（30．8±4．5）,P〈0．05];3组的日间ESS均有改善（P〈0．05）,轻度组由（8．8±2．0）降低到（6．0＋1．9）,中度组由（10．7±2．1）降至（8．0±2．3）,重度组由（13．4±2．4）降至（10．2±3．0）。相关性分析显示轻度组ESS与微觉醒指数呈正相关（r=0．775,P〈0．05）,而中重度组日间嗜睡评分与最低血氧饱和度呈负相关（分别为r=-0．751,P〈0．05;r=-0．739,P〈0．05）。结论通心络胶囊可改善老年睡眠期CSR者的日间嗜睡症状,可能部分降低重度老年睡眠期CSR的呼吸暂停低通气指数。